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Wisconsin Department of Safety and Professional Services <br /> Division of Industry Services <br /> SOIL EVALUATION REPORT Page_of_ <br /> in accordance with SPS 383,Wis. Adm. Code <br /> Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must County <br /> include,but not limited to:vertical and horizontal reference point(BM),direction and C'19 <br /> percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D.07- aZ' 4d-I 6l l�I Clr� �j <br /> �p0_ Q <br /> Please print all information. Review y Date <br /> Personal information you provide may be used for secondary purposes(Privacy Law,S.15.04(1)(m)). <br /> Property Owner <br /> Property Location <br /> PAS /� Govt.Lot 1/4 1!4 S 30 T y0 N R / ®r® <br /> Property Owner's Mailin/g Address Lot# Block# Subd. Name or CSKv y s <br /> 3 L l 3 (. 67 8 r-�ci PV e f�, Dr d 1�.a y P 198 <br /> City State Zip Code Phone Number ity Village <br /> fir/ (71S') ��/� 77�jQ Town Nearest Road d��gD <br /> S� 7770 .so+') /' <br /> rA New Construction UselM Residential/Number of bedrooms � Code derived design flow rate 200 <br /> nReplacement ® GPD <br /> P Public or commercial-Describe: <br /> Parent material �/a G I /�p ;�-� Flood Plain elevation if applicable AJ General comments <br /> and recommendations: Sy s' N AeV 9313 <br /> ❑ Boring# 11 Boring p <br /> Q Pit Ground surface elev. //o. 3 ft. Depth to limiting factor � �� in. <br /> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Soil Application Rate <br /> �' GPD/if <br /> in. Munsell <br /> Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 <br /> -2-5- — > Fs �1. ,sGIz <br /> 'S— /, b <br /> 7 1, 6 <br /> ® Boring# n Boring <br /> Pit Ground surface elev. g�'3 ft. Depth to limiting factor > 7 Z/ in. <br /> Soil A lication Rate <br /> Horizon Depth Dominant Color Redox Description TextureE <br /> re Consistence Boundary Roots GPD/fF <br /> in. Munsell Qu.Sz. Cont.Color <br /> h. 'Eff#1 'EfF#2 <br /> ,�, ( c. s <br /> ti a 7. 5''/f7 <br /> f? <br /> *Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD �30 mg/L and TSS<30 mg/L <br /> CST Name (Please Print) gnature 7 T Number <br /> Address Date Evaluation Conducted <br /> d77(o(I l�+.t 1✓�/P�l�teN � �yd L/y /� Telephone Number/ <br /> 7/s ?G6-y/s-7 <br /> SBD-8330(R07/13) <br />